The PT/PTA Billing Dynamics
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Sometimes I wonder about the future. Two years from now when I’m a newly licensed physical therapist, I suspect that I’ll worry about remembering all the positions for measuring range of motion, what cranial nerves are affected and when, or what the extensor carpi radialis does. I also suspect I’ll worry about understanding the administrative aspects of our business, like billing appropriately.
The first step in understanding this important process is to become familiar with the factors that impact billing and payment. These factors include state practice acts, federal policies, payer policies, and employer or setting policies.
Some payers will have different requirements based on the treatment setting. For example, in a private practice setting Medicare rules require that services provided by a physical therapist assistant be under the direct supervision of a physical therapist. In other settings Medicare rules require only general supervision. Ultimately, the most stringent requirement must be met, whether that is the state practice act, the payer policy, or the employer policy.
The provision and billing of services when provided by a physical therapist–physical therapist assistant team is complex. It is the responsibility of the physical therapist to know under what conditions certain interventions can be delegated to a physical therapist assistant and how those services must be supervised, documented, and billed. When a physical therapist does delegate components of care to a physical therapist assistant, the documentation must include evidence that the physical therapist established the plan of care and reviewed it with the PTA, and that the care is being provided under the supervision of the physical therapist.
It is important to note that billing is tied to the supervision requirements in each state’s practice act and each payer’s policy requirements, so make sure to look at your state practice act and payer policy for this information. For example, cosignature requirements vary by state, payer, and setting. APTA’s website provides extensive resources related to the PT–PTA team.
In recent news, the Medicare therapy cap was finally repealed after 20+ years of advocacy from leaders in our profession. Unfortunately, along with elimination of the hard cap, a differential payment rate was established for physical therapist assistants that is set to start in 2022. In this new payment system, PTAs will only be reimbursed at 85% for outpatient therapist services. APTA is working to ensure that guidance to implement this new policy does not impede access to necessary care.
I believe that a greater understanding of these issues as students makes us better equipped to enter our clinical rotations and our first jobs. Physical therapy students should know their roles and responsibilities regarding documenting appropriately to get paid for the expertise and services we studied so hard to learn. In the end, we want what’s best for our patients, and knowing how to bill appropriately ensures that we use the correct services to help get our patients better, faster.
State practice acts
Other helpful resources:
The Post-Therapy Cap System: 5 Basics You Need to Know
Use of Physical Therapist Assistants (PTAs) Under Medicare
Hannah Belles, SPT, is a current student at the University of Florida. You can connect with Hannah on Twitter at: @HannahBelles93.